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CT肺血管图像临床假测概率工具:对急诊室利用率的影响

Rachel P Rosovsky¹, Mark Isabelle², Nooshin Abbasi³

¹Director, Thrombosis Research, Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Co-Chair, Thrombosis Committee, Massachusetts General Hospital; President, The Pulmonary Embolism Response Team Consortium; Harvard Medical School, Boston, Massachusetts.

Journal of the American College of Radiology : JACR

|August 12, 2024

概括

一种新的临床决策支持工具显著减少了CT肺血管图 (CTPA) 在急诊室诊断肺栓塞 (PE) 的过度使用. 这种基于证据的方法使CTPA使用率降低了14.5%,而不会影响诊断准确度.

科学领域:

紧急医疗紧急医疗
放射学放射学是一门学科.
临床决策支持临床决策支持

背景情况:

CT肺血管图像 (CTPA) 经常在急诊室 (ED) 中过度使用,用于评估急性肺栓塞 (PE),往往导致诊断产量低.
优化CTPA利用对于减少不必要的辐射暴露和医疗保健成本至关重要.

研究的目的:

评估基于证据的临床决策支持 (CDS) 工具对CTPA用于EDS急性PE诊断的使用的影响.
评估在实施CDS工具后CTPA利用率和诊断产量的变化.

主要方法:

在一个大型医疗保健系统中,在九个学术和社区医院进行了全系统的CDS工具实施.
在12个月的干预前期 (2021年6月至2022年5月) 和12个月的干预后期 (2022年6月至2023年5月) 中,CTPA利用率和收益率进行了比较.
使用统计过程控制图表和后勤回归分析来评估与PE诊断相关的趋势和因素.

主要成果:

与干预前 (3.26%的访问) 相比,CTPA利用率在干预后下降了14.51% (2.79%的访问),这代表了统计学上显著的减少 (P < .001).
CTPA的诊断收益率保持稳定,在两个时期之间没有观察到显著的变化 (干预前9.25%与干预后8.92%;P = .34).
在CTPA之前被诊断为COVID-19的患者显示急性PE的概率更高,CTPA利用的季节性变化也被注意到.

结论:

基于证据的CDS工具的实施导致CTPA在EDs急性PE评估中的使用量大幅而持续减少.
该CDS工具有效地优化了CTPA的适当使用,而不影响诊断产量,证明了其在临床实践中的价值.

关键词:

CT肺血管图像 (CT) 肺血管图像临床决策支持临床决策支持临床预试验概率工具肺栓塞肺栓塞是一种肺栓塞.质量改善质量改善

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